Background
Methods
Study design
Participant recruitment
Randomization & blinding
The interventions
Supervisor telephone contact (STC)
Common practice (CP)
Data collection and valuation
Data analysis
Sensitivity analysis
Results
Participants and data availability
Patients baseline measures | STC (N= 265) | CP (N= 276) | |
---|---|---|---|
Mean age in years (S.D.; range) | 32 (4.0; 19-45) | 32 (4.3; 19-42) | |
Marital status, N (%) | Single/Divorced | 6 (2%) | 8 (3%) |
Common law/Married | 259 (98%) | 268 (97%) | |
Level of education, N (%) | Low | 25 (9%) | 24 (9%) |
Intermediate | 87 (33%) | 96 (35%) | |
High | 153 (58%) | 156 (57%) | |
1st pregnancy, N (%) | 126 (48%) | 133 (48%) | |
Hours worked per week, N (%) | 12-23 | 64 (24%) | 61 (22%) |
24-35 | 122 (46%) | 145 (53%) | |
> 36 | 79 (30%) | 70 (25%) | |
Predominant type of work, N (%) | Seated | 94 (36%) | 77 (28%) |
Standing | 58 (22%) | 71 (25%) | |
Hand | 109 (41%) | 115 (42%) | |
Heavy | 4 (2%) | 13 (5%) | |
Pre-partum sick leave hours, mean (S.D.) | 1 year before pregnancy | 69 (155) * | 66 (147) * |
Pregnancy until start of maternity leave | 112 (158) * | 109 (178) * | |
Health care use, mean (S.D.) | General practitioner | 0.3 (0.7)
†
| 0.3 (0.6)
†
|
Midwife | 0.2 (0.5)
†
| 0.3 (0.7)
†
| |
Gynaecologist | 0.2 (0.5)
†
| 0.2 (0.5)
†
| |
Post-partum home care | 40.0 (19.5) ‡
| 39.3 (19.2) ‡
| |
Partner | 27.2 (43.3) ‡
| 28.3 (45.6) ‡
| |
Family/friends/volunteers | 8.1 (21.4) ‡
| 11.7 (25.4) ‡
| |
Utility, mean (S.D.; range) | 0.92 (0.12; 0.31-1.0) ¶
| 0.91 (0.13; 0.17-1.0 ) ¶
|
Resource use
Pre-intervention period (1st6 weeks post-partum)*
| Post-intervention follow-up (6-52 weeks post-partum)*
| 52-weeks post-partum*
| ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
STC | CP | STC | CP | Pooled total | ||||||||
HEALTH CARE SECTOR
|
Units
|
Price weight
(in €)
|
%
|
Mean (S.D.)
|
%
|
Mean (S.D.)
|
%
|
Mean (S.D.)
|
%
|
Mean (S.D.)
|
%
|
Mean (S.D)
|
General practitioner | [No. of consults] | 21.03 †
| 23 | 0.3 (0.7) | 23 | 0.3 (0.6) | 49 | 1.2 (1.9) | 53 | 1.1 (1.6) | 57 | 1.5 (2.0) |
[No. of tel. consults] | 10.51 †
| 14 | 0.2 (0.6) | 17 | 0.2 (0.5) | 16 | 0.3 (0.7) | 19 | 0.3 (0.8) | 29 | 0.5 (1.0) | |
[No. of house calls] | 42.05 †
| 8 | 0.1 (0.4) | 12 | 0.2 (0.7) | 3 | <0.1 (0.2) | 2 | <0.1 (0.1) | 13 | 0.2 (0.6) | |
Nurse practitioner | [No. of consults] | 21.03 †
| 1 | <0.1 (0.1) | 3 | 0.1 (0.4) | 3 | <0.1 (0.2) | 4 | 0.1 (0.4) | 6 | 0.1 (0.4) |
[No. of tel. consults] | 10.51 †
| 2 | <0.1 (0.2) | 3 | <0.1 (0.3) | 3 | <0.1 (0.2) | 1 | <0.1 (0.2) | 5 | 0.1 (0.3) | |
[No. of house calls] | 42.05 †
| 3 | 0.1 (0.4) | 3 | <0.1 (0.3) | 0 | 0 (0) | 0 | 0 (0) | 2 | <0.1 (0.2) | |
Midwife | [No. of consults] | 12.13 †
| 17 | 0.2 (0.5) | 19 | 0.3 (0.7) | 6 | 0.1 (0.2) | 9 | 0.1 (0.3) | 23 | 0.3 (0.7) |
[No. of tel. consults] | 6.06 †
| 4 | 0.1 (0.3) | 5 | 0.1 (0.3) | 0 | 0 (0) | 0.5 | <0.1(0.1) | 5 | 0.1 (0.4) | |
[No. of house calls] | 24.26 †
| 25 | 0.7 (1.4) | 23 | 0.7 (1.5) | 0 | 0 (0) | 1 | <0.1 (0.1) | 24 | 0.7 (1.5) | |
Obstetrican/Gynaecologist | [No. of consults] | 58.29 †
| 15 | 0.2 (0.5) | 15 | 0.2 (0.5) | 20 | 0.3 (0.8) | 21 | 0.3 (0.8) | 29 | 0.5 (1.0) |
[No. of tel. consults] | 29.15 †
| 2 | <0.1 (0.1) | 4 | 0.1 (0.3) | 1 | <0.1 (0.1) | 1 | <0.1 (0.1) | 1 | <0.1 (0.1) | |
Other Medical specialist | [No. of consults] | 58.29 †
| 2 | <0.1 (0.3) | 4 | 0.1 (0.4) | 12 | 0.3 (1.0) | 14 | 0.3 (0.8) | 14 | 0.3 (1.1) |
[No. of tel. consults] | 29.15 †
| 1 | <0.1 (0.9) | 1 | <0.1 (0.1) | 4 | 0.1 (0.6) | 2 | 0.1 (0.4) | 4 | 0.1 (0.5) | |
Hospitalizations | [Length of stay in days] | 350.80 †
| 18 | 0.6 (1.7) | 17 | 0.6 (1.8) | 2 | 0.1 (0.5) | 2 | 0.1 (0.5) | 20 | 0.7 (1.8) |
Uncomplicated delivery | [Length of stay in days] | ... | 8 | 2.7 (1.6) | 6 | 2.4 (2.0) | ... | ... | ... | ... | 6.9 | 0.2 (0.8) |
OB-GYN-assisted | [Length of stay in days] | ... | 0 | 0 (0) | 1 | 11 (1.4) | ... | ... | ... | ... | 0.2 | <0.1 (0.6) |
C-Section | [Length of stay in days] | ... | 4 | 5.1 (1.3) | 5 | 4.1 (1.2) | ... | ... | ... | ... | 5.3 | 0.2 (1.1) |
Peri-partum complications | [Length of stay in days] | ... | 6 | 3.4 (3.0) | 6 | 3.4 (3.1) | <1 | 0.2 (1.1) | 1 | 0.2 (1.1) | 6.2 | 0.2 (1.0) |
Other post-partum complications | [Length of stay in days] | ... | 0 | 0 (0) | 0 | 0 (0) | 1 | <0.1 (0.4) | 2 | <0.1 (0.4) | 1.7 | 0.1 (0.5) |
Psychologist | [No. of sessions] | 76.90 †
| 0 | 0 | <1 | <0.1 (0.1) | 4 | 0.2 (1.5) | 1 | 0.05 (0.59) | 3 | 0.1 (1.1) |
Other psych specialists | [No. of sessions] | Variable ‡, §
| 1 | <0.1 (0.1) | 1 | <0.1 (0.1) | 2 | 0.1 (0.5) | 2 | 0.1 (0.7) | 3 | 0.1 (0.6) |
Physical therapist | [No. of sessions] | 23.68 †
| 2 | 0.1 (0.5) | 5 | 0.1 (0.9) | 18 | 1.5 (4.6) | 11 | 0.8 (3.1) | 15 | 1.2 (4.1) |
[No. of fitness sessions] | 13.20 ‡
| 0 | 0 (0) | 0 | 0 (0) | 1 | <0.1 (0.4) | 1 | 0.1 (0.7) | 1 | 0.1 (0.5) | |
Manual therapist | [No. of sessions] | 32.75 ‡
| 0 | 0 (0) | 0 | 0 (0) | 5 | 0.2 (0.8) | 2 | 0.1 (0.9) | 3 | 0.1 (0.9) |
Exercise therapist-Mensendieck | [No. of sessions] | 23.94 †
| 1 | <0.1 (0.2) | 2 | <0.1 (0.4) | 3 | 0.1 (1.2) | 3 | 0.4 (2.3) | 3 | 0.3 (2.0) |
[No. of fitness sessions] | 11.60 ‡
| 0 | 0 (0) | 1 | <0.1 (0.3) | 0 | 0 (0) | 0.5 | 0.2 (2.6) | <1 | 0.1 (2.0) | |
Other paramedical professionals | [No. of sessions] | Variable §
| 0 | 0 (0) | 1 | <0.1 (0.4) | 5 | 0.2 (0.9) | 2 | 0.1 (1.2) | 4 | 0.2 (1.1) |
Medications | [% ] | Variable ¶
| 64 | 66 | ... | ... | 75 | |||||
Maternity aid | [Hours] | 31.06 †
| 97 | 40.0 (19.5) | 98 | 39.2 (19.1) | ... | ... | ... | ... | 98 | 39.6 (19.3) |
Professional home/family care | [Hours] | Variable †
| 2 | 0.4 (3.6) | 2 | 0.5 (4.0) | 0 | 0 (0) | 0.5 | 0.1 (1.2) | 2 | 0.4 (3.5) |
OTHER SECTOR
| ||||||||||||
Occupational health physician | [No. of consults] | 34.01 §
| <1 | <0.1 (0.1) | 0 | 0 (0) | 8 | 0.2 (0.8) | 7 | 0.1 (0.4) | 7 | 0.2 (0.6) |
[No. of tel. consults] | 11.34 §
| 1 | <0.1 (0.1) | 1 | <0.1 (0.1) | 5 | 0.1 (0.5) | 7 | 0.1 (0.5) | 6 | 0.1 (0.5) | |
Occupational consultant/nurse | [No. of consults] | Variable §
| 0 | 0 (0) | 0 | 0 (0) | 0.5 | <0.1 (0.1) | 0.5 | <0.1 (0.1) | <1 | <0.1 (0.1) |
[No. of tel. consults] | Variable §
| 0 | 0 (0) | 0 | 0 (0) | 0.5 | <0.1 (0.1)) | 1 | <0.1 (0.1) | 1 | <0.1 (0.1) | |
Employer-covered fitness | [No. of sessions] | Variable §
| 0 | 0 (0) | 0 | 0 (0) | 0 | 0 (0) | 0.5 | 0.1 (2.1) | <1 | 0.1 (1.5) |
All alternative care providers | [No. of sessions] | Variable §
| 2 | <0.1 (0.1) | 2 | <0.1 (0.1) | 3 | 0.1 (0.8) | 4 | 0.1 (0.8) | 4 | 0.1 (0.8) |
PATIENT & FAMILY
| ||||||||||||
Extra paid household help | [Hours] | 8.64 †
| 2 | 0.5 (6.5) | 3 | 0.3 (1.9) | 11 | 1.5 (6.4) | 9 | 1.3 (6.2) | 11 | 1.6 (6.7) |
Extra day care | [Hours] | 5.63 §
| 1 | 0.1 (6.5) | 1 | 0.2 (3.3) | 3 | 0.5 (3.4) | 2 | 0.2 (1.5) | 3 | 0.5 (3.7) |
Partner | [Hours] | 8.64 †
| 52 | 27.2 (43.3) | 51 | 28.3 (45.6) | 31 | 13.1 (32.3) | 19 | 18.3 (59.1) | 58 | 42.5 (74.2) |
Family/friends/volunteers | [Hours] | 8.64 †
| 31 | 35 | 11.7 (25.4) | 27 | 6.5 (21.6) | 21 | 6.6 (22.2) | 43 | 15.4 (33.5) | |
Sport or physical fitness activity | [%] | Variable §
| 6 | ... | 6 | ... | 31 | ... | 30 | ... | 31 | ... |
PRODUCTIVITY LOSS
| ||||||||||||
Sick leave from paid work | [Hours] | 31.72 ** | ... | ... | ... | ... | 41 | 20.5 (60.6) | 45 | 19.8 (49.0) | 43 | 20.4 (55.4) |
Work presenteeism | [Hours] | 31.72 ** | ... | ... | ... | ... | 58 | 22.1 (35.2) | 57 | 20.6 (29.8) | 58 | 21.7 (32.7) |
Total productivity loss | [Hours] | ... | ... | ... | ... | ... | 71 | 42.6 (76.2) | 73 | 42.3 (64.6) | 72 | 42.5 (70.3) |
Costs, effects and cost-utility analysis
Components | STC* | CP* | Mean difference | Pooled†
|
---|---|---|---|---|
Mean (S.D.) | Mean (S.D.) | (95% CI) | Mean (95% CI) | |
Health care sector | 199 (375) | 169 (326) | 30 (-32; 99) | 1707 (1613; 1765) |
Other sectors | 11 (39) | 10 (51) | 1 (-8; 9) | 11 (8; 16) |
Patient/family | 273 (603) | 274 (616) | -1 (-121; 127) | 608 (528; 690) |
Sick leave | 662 (1682) | 625 (1655) | 37 (-252; 334) | 643 (506; 821) |
Work presenteeism | 765 (1164) | 655 (944) | 109 (-66; 298) | 709 (615; 804) |
Total productivity loss | 1427 (2297) | 1281 (2084) | 146 (-228; 528) | 1352 (1158; 1561) |
Total costs | 1911 (2867) | 1734 (2644) | 177 (-293; 678) | 3678 (3386; 3951) |
Analysis*
| Sample size | ΔC (95% CI) | ΔE (95% CI) | ICUR | Distribution in CU-plane | ||||
---|---|---|---|---|---|---|---|---|---|
STC | CP | NE†
| SE‡
| SW§
| NW¶
| ||||
Main | 260 | 272 | 177 (-293; 678) | -0.007 (-0.023; 0.009) | -25,440 ** | 10% | 9% | 14% | 67% |
SA1 | 260 | 272 | 186 (-350; 751) | -0.007 (-0.023; 0.009) | -26,774 ** | 10% | 9% | 16% | 65% |
SA2 | 252 | 260 | -194 (-295; 751) | -0.005 (-0.021; 0.117) | -42,569 ** | 17% | 13% | 10% | 59% |
SA3 | 200 | 210 | 41 (-404; 487) | 0.001 (-0.017; 0.015) | -40,939 ** | 20% | 25% | 17% | 38% |